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Nationwide rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,884.03 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,760.83 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $3,467.37 / $15,488.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,090.30 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $7,244.36 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,570.40 / $4,570.88